Risk factors for prostate cancer in men with false-negative mpMRI: A retrospective single center cohort study of image quality scores and clinical parameters

Abstract

PURPOSE

To identify predictors of prostate cancer (PCa) and clinically significant prostate cancer (csPCa) in men with prior false-negative multiparametric MRI (mpMRI), focusing on image quality scoring systems and clinical parameters.

METHODS

In this IRB-approved retrospective single-center study, patients with a negative mpMRI (PI-RADS score ≤2) and subsequent prostate biopsies were included. Histopathological results served as reference standard. Welch's t-Test was conducted to identify significant differences in image quality scores (PI-QUAL and PSHS) between patients with and without PCa/csPCA. In addition, clinical parameters (age, BMI, PSA density) and image quality scores (PI-QUAL and PSHS) were examined as potential predictors of PCa/csPCa detection after a false-negative mpMRI in uni- and multivariate analyses.

RESULTS

Among 96 patients with negative mpMRI results, 44.8 % had PCa and 16.7 % had csPCa upon biopsy with histopathological confirmation. PI-QUAL scores were significantly lower in patients with PCa (p = 0.03) and csPCa (p = 0.005). PSHS scores were lower in patients with csPCa, but the difference was not statistically significant (p = 0.1). Higher age (p = 0.035) and a lower PI-QUAL score (p < 0.004) were predictors of subsequent csPCa detection upon biopsy, however, a lower PI-QUAL score was the only independent predictor of missed csPCa in false-negative mpMRIs.

CONCLUSIONS

Lower image quality scores were associated with missed PCa/csPCa in patients with false-negative mpMRIs, with PI-QUAL being an independent predictor of failed csPCa detection. This highlights the importance of image quality for prostate MRI and advocats the inclusion of its measurement into the standardized report.